Should You Help Patients Die?

Azevedo, David, Medical Economics

Two landmark cases have reached the Supreme Court. Will they clear the way for doctors to be given this unspeakable power?

The 84-year-old man knew he had little time left. He was dying of lung cancer and suffering excruciating pain. His physician would prescribe only Tylenol, feeling anything stronger would be medically inadvisable. The man's family hinted that they'd acquire necessary medication if he chose to end his life. No, the man said, assisting in a suicide is illegal; I won't involve my family in a crime.

Instead, he chose another route, as his daughter later described: "When he realized that the family was--going to be away for -a day, he-wroteus a beautiful letter, went down to his basement, and shot himself with his 12-gauge shotgun... My son-in-law then had the unpleasant task of cleaning my father's splattered brains off the basement walls."

For some, stories like this are compelling arguments to legalize physician-assisted suicide. Patients in the final stages of agonizingly painful terminal illness often seek desperate measures to end their suffering. Wouldn't it be more humane, these advocates ask, if instead of resorting to firearms or other violent means, they could turn to their personal doctors for help in ending their lives?

Absolutely not, retort those opposed to physician-assisted suicide. They agree that the man's doctor holds the answer, but say it's a different answer: Manage pain better. "Two-thirds of physicians are incompetent at managing pain." says Pasadena, Calif., oncologist H. Rex Greene. "The war on drugs has produced an irrational fear among both doctors and the public that giving a dose of morphine might addict a patient and result in a whole cascade of disastrous events, even though science shows that doesn't happen."

More importantly, says Greene, "Those of us in the trenches caring for dying patients are hard-pressed to see a need for physician-assisted suicide. I've worked in hospice for 20 years, and I've had 13 patients ask me for help in dying. One, who was demented from a brain tumor, overdosed on medicine I prescribed, though I didn't intend him to kill himself. The others' requests were the result of brief depressions, which they got over. When terminally ill patients ask to die, it's not because they're in intractable pain, it's because they're depressed or fear that someday they'll suffer unmanageable pain or helplessness. We should be talking not about how to kill them, but rather how to better treat them."

Internist Timothy E. Quill, who made headlines in 1991 when he wrote in The New England Journal of Medicine about helping a patient die, has heard this before, and he doesn't like it. "Such requests could be the result of undertreated pain or unrecognized depression that might be relieved with good palliative treatment," he wrote to a congressional subcommittee last spring. "But these requests might also reflect fully considered, rational wishes to die.... It is selfdeceptive and demeaning to suggest that all requests for physician-assisted death result from inadequate caring by medical professionals or from psychopathology or spiritual weakness by patients."

THE SUPREME COURT enters the picture

Quill is a plaintiff in a lawsuit that seeks to legalize physician-assisted suicide. Along with a companion suit, the case has reached the United States Supreme Court. The court was scheduled to hear arguments this month, and a decision is expected by summer. It could be every bit as revolutionary as the Roe vs. Wade abortion ruling.

Specifically, the suits contend that states are constitutionally prohibited from making it illegal for doctors to give mentally competent, terminally ill adults prescriptions that will enable those patients to kill themselves. (More than 40 states outlaw the practice by legislation or case law.) Supporters of such physician-assisted suicide disapprove of the term, preferring "aidin-dying" or "hastening death. …

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